Your issue needn’t be Googled in order to understand its significance, but you Google regardless, and Google confirms the ugly possibilities that have been surfacing in your brain from the moment you began shitting blood.

There is blood where there shouldn’t be, and so much hurt where your guts are, and there are a number of conditions symptoms such as this may signify, but you only notice cancer because six years ago you came down with cancer of the breast variety.

***You live with your wife in a small mountain town, but you would rather be sick in a city. This is one of several ways in which you are an elitist, a snob.

Alas, you are sick on top of a mountain. Your only context for mountain illness, until now, was Heidi.

Sometimes you find charm in small mountain town living, as when the snows come, heavy and deep, and melt quickly beneath the high altitude sun. Or when you invariably run into a student at the grocery store who is probably embarrassed to see her English teacher engaged in the mundane task of picking out garlic bulbs.

You do not find small towns medically charming. Small town doctors make you wait, their nurses exude exhaustion-induced aloofness, they place you in the pediatric exam room because all the others are full.

You sit beneath a cluster of spotted baby deer painted on a pale yellow wall; deer make you think of the Midwest, and you feel acutely homesick.

You note how small the exam table is and wonder how you’ll fit there. You are, in fact, smaller now. Your skinny jeans are baggy. Your abdomen, which a month ago, was filling out with forty-fat has deflated. Your face has narrowed. You are smaller, but not child-small -- you only feel this way.

You were going to put off this appointment, wait for school to start. You said you needed to “get your classes going” before seeing a doctor; really, you were afraid to know what was wrong. At your wife’s insistence, you saw the doctor sooner.

This, I suppose, is why married people live longer, you obliged.

The Mountain Doctor asks about your history with cancer. There’s really nothing else in your medical history to discuss, just your poor eyesight caused, you believe, when Scarlet Fever scorched through your six-year-old body.

When you tell Mountain Doctor you’ve been shitting blood you speak delicately, bloody stool, and the polite diction seems like a lie and just as crude as the alternative.

He says he can’t help you.Take as much Tylenol as you need.See a gastroenterologist.There’s a long wait, he tells you. But I’ll explain that it’s urgent.

Your wife is there with you for moral support.

When Mountain Doctor leaves the room you turn to her and say, I’m dying.

You’re not, she assures.

I am. Why else would he think this is urgent?

Because you’re gray in the face, she says. Because you’ve lost nearly thirty pounds in what? Four weeks?

As does one who is dying.

***Illness is a particular form of solitude.

You remember fever hallucinations from Scarlet Fever. This is one of your earliest memories: your father’s voice slow and amplified as he set wet washcloths on your forehead. He wasn’t really shouting or slurring, and on some level you understood this, understood you were trapped with your head, alone in the delirium.

And the winter of 1989 spent in the hospital recovering from surgeries and staph infections. Your friends went sledding and met up with boys at the mall, and you watched Johnny Carson with a nurse from India who’d been schooled by the British. You liked the way she said “bath.” But you didn’t like Johnny Carson, and the nurse was a hired employee, and you were fourteen years old, alone in your infected body.

And you said “no” to all the cancer support groups. You stayed home with your records and your writing and the battery of steroids and painkillers doctors had given you as well as the marijuana a stoner friend had gifted as a condolence. This is what you knew how to do, you’d had practice: get sick, be alone with your head, your treacherous body.

Your wife eats her dinner beside you in bed. You barely speak. She offers to bring you things: crackers, books, tea. You decline with a mumble and a grunt. You’ve climbed inside of the pain, sunk eye-deep into your own mortality. She believes you’ve gone cold. She feels rejected. You can’t explain, much less justify, your distance. The body weights the brain. The self is inverted. You are all noise and sensation, so you make silence, foster depravation.

***School begins. Six classes at your full-time job. One night class you took at the community college “for fun.”

The gastroenterologist raises his eyebrows when you explain your schedule, asks if you’ve considered medical leave.

You’re worse now than when you saw Mountain Doctor. You’ve stopped eating entirely. You’ve lost track of how much Tylenol you’ve taken. You’re bleeding six to eight times a day. But work is what you do. You teach your classes just like you did when you had cancer. This was a source of pride then; you scheduled your chemo for days when you didn’t have class. But you feel sicker now than when you had cancer. You are drawn, ashen; you look like your grandfather looked in the months before he died of lung cancer.

You don’t feel resilient now. You couldn’t get your classroom books on their shelves, had to ask the younger English teacher to help with that, watched from a seated position as she slid Crime and Punishment, The Wasteland, Mrs. Dalloway into the bookcases. You felt ashamed, fatal.

It’s perfectly safe, he tells you. Unless in the hands of a retarded cardiologist with a revoked medical license.

You laugh in shock at his use of the word “retarded,” but you like that he knew what you were thinking, that he was able to break the barrier into your isolation.

Then he asks about cancer.

Lumpectomy?

Yes.

Chemotherapy?

Yes.

Radiation?

Yes.

You’d rather keep talking about Michael Jackson, about Thriller, about the Moonwalk, the glitter glove, Pepsi commercials. The memory of cancer sometimes hurts the way your guts hurt, you wish it wasn’t there.

All you ever really wanted was to smoke some goddamn cigarettes, write some good prose, and drink whisky, beer, whenever you fucking pleased. All you ever wanted was to live by your own rules and die swiftly, but intact.

You know some people are allowed this. Some people get to be fat and boozy and smoky and their cells never warp, their guts never burn. Fuck those people, you think.

It’s a dark pain, you told your wife when she asked. Something evil.

The dark pain wakes you in the night.

You’ve noted, during Google searches, pain isn’t supposed to wake you in the night, and the pain that does is most pernicious.

The memory of cancer, too, is a dark pain that wakes you in the night.

But you must discuss your guts, and you must discuss cancer. Sometimes you discuss cancer with strangers because you wrote a book about it. You were candid. You were bare. You told the whole story. And yet, each time you’re made to discuss your relationship with malignancy, whether with your wife or a reader, a mean sun, bright with terror and embarrassment, burns in your chest.

Fuck cancer, people say.Fuck cancer, as though cancer cares.What we always mean is fuck death.

***You await the urgent colonoscopy. You teach your classes.

Your veins are terrible: thin, elusive. Multiple attempts at a recent blood draw left your hand and wrist scabbed, bruised fiercely. As he fished beneath your flesh for a blue line to lance, the lab tech mistook your fatigue for stoicism.

You move your battered hand to the white board, and your students stare at the dark, purple clouds. You dig through pain so that you might, with a modicum of intelligence, address the first three cantos of Dante’s Inferno.

“Midway upon the journey of our lifeI found myself within a forest dark”

Two months ago, when you turned forty, you wondered if you were midway upon the journey or well past. Forty felt like an accomplishment, an impossibility.

Funny we should be discussing hell, you want to tell your high school students. Their eyes travel again and again to your hand, your wrist.

Unable to stomach water, you chew a Tylenol while the students write in their journals. This is the pattern: when the pain causes you to pause, they write in their journals.

You wonder if any suspect you are sick.

You lean into your desk and explain Terza Rima.

Why did he write it that way? A student asks. Like does it add to the meaning?

Well, it is quite a feat, you say, unable to formulate a better response. All metaphorical significance incinerated by the fire in your guts, pain eclipses complexity.

Surely there is a greater meaning. You want badly to believe in meaning, but if the pain grows steadily worse, if you are unable to stand on your disappearing legs, if you starve, and your innards liquefy and you shit them all out, where is the meaning?

***You call your mother. You’re not particularly close, but you crave her in a way that can only be described as “primal.” You don’t want to alarm her, so you joke about how much you’ve appreciated the drastic weight loss. You joke about having a camera put up your ass. You tell her about the pediatric exam room, and that your gastroenterologist said “retarded.”

You don’t tell her about the copious blood, how it’s hard to stand up straight, that you’ve stopped eating and are subsisting on fruit-punch flavored Vitamin Water, you don’t tell her how the pain takes your breath away, or that your wife says you’ve been whimpering in your sleep.

Despite your omissions, she is alarmed.

***The night before the colonoscopy, you sit in bed, drinking the thick, salty prep solution and watching The Wonder Years. The orange kitten you and your wife adopted, just as you began to fall ill, bites your toes and the pain of kitten teeth atop the pain in your gut is extraordinary. You tell the kitten to “fuck off,” and feel guilty.

You hold your nose and swallow. You must drink a gallon. You cough and gag, tell your wife this is torture.

I know, baby, she sympathizes. But don’t throw it up.

The whole of your abdomen hurts now: sides, belly, groin. The source of the pain is obscured by more pain. You wonder if this could be gynecological.

The Tamoxifen you take to keep breast cancer at bay is known to cause uterine cancer. Chemotherapy is known to cause leukemia. Radiation therapy is known to cause cancer in other, initially unaffected, body parts. The Prednisone you started last week causes “moon face.” The Bentyl to treat the pain of diarrhea may cause worsening diarrhea.

In a sad effort to be quotidian, you once heard someone say, “death is a side effect of living.” Side effects, however, are speculations whereas death is certain. And you hate that you have to end, you hate not knowing where you go, and you hate that the older you get the more atheist you become.

You cry about dying, and, ironically, drinking the prep makes you wish you were dead.

***Your wife comes home early to drive you to your appointment. When the receptionist asks who’s come with you, you stammer a trinity of descriptors in quick succession: my partner, my spouse, my wife.

Small town. You are still unsure what to say in order to insure the comfort of others. In your condition, you don’t know why you even care.

You are afraid, and you’re ashamed of being afraid of a colonoscopy. You’ve been through so much worse, you remind yourself. But illness is not like your fear of flying, it doesn’t get easier the more you do it. Time advances, the body degrades, every illness takes a new piece away. Bravery is proportionate to your proximity to the grave.

You remove your sweatpants and your underwear and set them on a chair beside the gurney. You put on the gown, open in the back, not in the front as when you see your oncologist.

The nurse who comes to place your IV line observes that you seem young for a colonoscopy. It’s nice to be told you’re still too young for something.

You tell her no needles can go into your left arm because of lymph node removal. Cancer surgery, you explain.

She blows a vein. A thin rivulet of blood runs over your bruises. She apologizes profusely and you feel bad that she feels bad. She calls a second nurse for help, and you watch the screen at the end of the bed tracking your rising pulse.

When did you have cancer? The second nurse asks, almost conspiratorial.

Thirty-four.

Family history? She’s conversing with you, genuinely curious.

No, you say. Just me. Cancer and bad eyesight. I get the good stuff.

Why are you here today?

You shrug, Mysterious intestinal problems.

The nurse finds a vein, tells you you’ve got a great anesthesiologist. She calls him by his first name, and you recognize the name because it is an unusual one. When he arrives to introduce himself, the recognition is mutual; he’s the father of three of your students, you’ve met him on multiple occasions at school. There is but one degree of separation between your students and a colonoscopy. Worse, last year, his daughter failed your class and did not graduate.

He’s got the Propofol. And while you appreciate the mercy provided by such drugs, you despise the bite of dreamless eternity they deliver. There’s such danger in being rendered so deeply absent.

You ask after the anesthesiologist’s daughter. How is she?

He tells you she’s gone to Chicago, and you don’t ask why. He seems eager to abandon the subject altogether, and asks what you do for fun.

Fun? You repeat, as though you’ve never heard the word before. Indeed, lately, the word has been hard to fathom. You tell him, dumbly, that you’ve been unable to eat and have recently taken an interest in looking at pictures of food online. This is not untrue.

When he prepares the Propofol, the solution is white as you read. You think again of Michael Jackson. You were shocked, but not sad, when he died. Your girlfriend at the time was crestfallen, and you feigned that you shared in her grief. You actually faked grief to appease her. How peculiar love once made you.

Ready to take a nap? Asks the anesthesiologist. You want to ask him if “everything’s cool” in regard to the daughter situation. You don’t want there to be any hard feelings before he puts you under.

Instead, you nod, and turn onto your side as directed.

Read any good books lately? He asks, pressing the white fluid into your line.

The relief has made you ravenously hungry. Hungry to get the fuck out of that building, to tell your wife what you’ve learned of Michael Jackson’s drug of choice, to plan tomorrow’s lessons. You want to fill yourself with sleep and ice cream and Vicodin. You are aching and weak, but delirious with the peculiar, albeit familiar, sensation of feeling acutely, urgently, alive.And here is the comfort, here is the meaning: a new thing ails you, and you will surely die, but likely not today, and surely not of this.

About the Author: Allison Gruber is the author of You’re Not Edith (George Braziller Inc., 2015) which was a finalist for a Lambda Literary Award. Her essays have appeared in The Huffington Post, The Literary Review, The Hairpin, and Foliate Oak, among many others. A Chicago native, Gruber now teaches literature and creative writing in Flagstaff, Arizona, where she lives with her wife.